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Click the report type below to jump directly to that section:
Claim List Reports
Patient List Reports
Patient Receipt Reports
Patient Visits Reports
Statements/Receipts for Nelco Perforated Forms
Statement - Sample - Standard statement showing charges, payments, and aging. Will only print if the patient has a balance due. Shows all transactions from claims not check marked as 'Paid'.
Statement with only Patient Balances - Sample - Standard statement but will only show service lines that have the responsible party set to '3 - Patient', the claim is not archived, and the claim's 'Paid' check box is unchecked.
Statement with Return Slip no Diags no Tax ID no Phone Number - Sample - Statement report with a return slip. No diagnostic codes, no Tax ID, and no phone number.
Statement for Payer Billing - Sample - Statement report with a return slip. Shows the Payer address on the left and the patient name on the right. Updated 3/20/2006 to allow a date range to be entered.
Statement with Return Slip no Diags no Tax ID using a Date Range - Sample - Statement with date range report with a return slip. No diagnostic codes are shown. The Tax ID is not shown.
Monthly Statements - Sample - Monthly statements will print even if the patient has a zero balance and no matter what the Balance - Responsible Party is set to. The statement will print data from all claims 'not archived' and 'not paid'. The provider Tax ID is removed and the diagnostic codes are removed.
Statement with Facility Return Address with Pmt Ref 1 and 2 Fields - Statement report with Facility Return Address including payment ref 1 and 2 fields.
Statement with Return Slip no Diags with Pmt Ref 1 and 2 Fields - Sample - Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes.
Statement with Return Slip no Diags no Procedure with Pmt Ref 1 and 2 Fields - Sample - Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes and no procedure codes.
Statement with Return Slip no Diags no Procedure with Pmt Ref 1 and 2 Fields no Tax ID- Sample - Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes and no procedure codes and no Tax ID.
Statement for Self Pay Patients - Sample - Statement report without the insurance information. This statement ignores the responsible party setting and assumes all balances are the responsibility of the patient.
Statement for Self Pay Patients with Ref Fields 1 and 2 - Sample - Statement for Self Pay Patients with payment reference fields 1 and 2.
Statement w No Tax ID - Sample - Statement report without the providers tax ID listed. Updated to use the reason code description for contract adjustments. Updated to include the second address line for the return address.
Nelco Statements can include change of address and credit card payment details. See the Nelco web site for more information. Only use the statement forms that are marked 'Perf at 3 1/2" from top.'
Statement for Nelco Forms w Balance Forward no Tax ID - 'Bill To' field available (more info).
Patient Receipt for Nelco Perforated Forms No Tax ID - 'Bill To' field available (more info).
Claim List - Sample - List showing claim totals. Grouped and subtotaled by Patient Group.
Claim List with Outstanding Balance - Shows claims that have an outstanding balance.
Claim List Detail by Rendering Provider - Sample - Shows patient name, ID number, service date, procedure, units, charges, co-pay, insurance payment, and adjustment. Grouped by rendering provider, patient, then claim. Includes the patient visit count.
Claim List Detail by Payer - Sample - Shows patient name, ID number, service date, procedure, units, charges, co-pay, insurance payment, and adjustment. Grouped by payer, patient, then claim. Includes the payer phone number.
Claim List Detail - Sample - Fixed an issue where patient names are shown even if they do not have a middle initial. Same as the Claim List report but shows service line detail along with the diagnostic codes. Now uses patients' middle initial.
Claim List with Orig Ref No - Claim List showing the Original Reference Number.
Accounts Receivable Report - Sample- AR report showing outstanding charges, credits, and open balance to the patient, primary and secondary insurances. Includes last charge, last payment, and aging. Can double click to drill down and see detail data. Each patient group is printed on a new page.
Accounts Receivable Report by Date Range - Sample - Normal AR report but allows you to use a date range. We suggest using the Claim Bill Date as the date range source. If you do not want to see $0.00 balance patients, select the 'Not Paid' option in the Claim Status criteria on the reports window.
AR Report Aged by Responsibility Change Date - Same as the standard AR report except the aging is calculated by the responsible party change date.
Patient Receipt - Sample - Standard receipt to print for a patient. Normally would be printed for a single claim.
Patient Visits - Sample - Shows patient name, date, procedure, units, charges, and applied amount. Grouped and subtotaled by patient group and facility. Includes the patient visit count.
Patient Visits Not Authorized - Sample - Shows patient name, procedure, units, charges, and applied amounts. Grouped by patient group, patient, and claim. Includes number of visits, claim ID, authorization number and detail information for services not authorized.
Patient List - Sample - Shows the patient name, phone, last date of service, ID number, account number, status, and balance. Grouped by patient group.
Patients Last Seen Between X and Dates - Sample - Patient list showing patients last seen during a date range. When you click the Print or Preview button, the program will prompt you for the start and end dates.
Patient List - Sample - Added the patient gender and date of birth. Increased the width of the Insured's ID Number field to account for longer ID numbers. Fixed the Patient Count field to be correct if any of the patients have no claims.
Patients Not Seen for X Number of Months - Sample - Shows a list of patients not seen within the last X months. The patient must have at least one service line so the report can calculate the last visit. If a patient does not have any service lines entered, they will not appear on the list.
Other Adjustments - Sample - Shows patient name, adjustment date, amount, and the claim ID. Grouped and subtotaled by the adjustment code.
Payments By Date - Sample - Shows patient name, claim ID, payment date, patient payment, insurance payment, secondary payment, contract adjustment and other adjustment. Grouped and subtotaled by patient group and payment date. IMPORTANT: A payment date must be entered for the payment to show on the report.
Payments By Reference - Sample - Shows the patient name, service date, payment type, payment date, and amount. When the report is run, it will ask for the reference to show. Enter the reference number or use the * character as a wild card. Example, AB* will show all payments will a reference starting with AB.
Claim Notes - Sample - Shows the patient name, and the claim notes for each claim. Also shows the first claim date, total charge, and balance due.
Daily Summary - Sample - Shows all transactions for a date period. Includes the patient name, transaction date, code, charges, payments, and descriptions. Grouped by patient group, provider, day, and type. Subtotals by provider, day and patient group.
Deposit Slip - Sample - Shows the patient name, payment amount, and reference number. Grouped by transaction date, reference 1, and patient name.
Patient Ledger - Sample - Shows the patient and billing contact details, transaction date, code, description, rendering provider, and amount. Includes balance of all transactions.
Patient Notes - Sample - Shows the patient name, ID number, account number, phone number and notes.
Procedure Code Summary - Sample - Shows the procedure, units, charges, all payments and totals by procedure code and gives a grand total. When the report is opened, you can enter a single procedure code or use the * character as a wild card. Example, if you enter 9*, it will show all procedures starting with a 9.
Production Summary - Sample - Shows the production of the rendering providers. Totals the charges, contract adjustments, other adjustments, and payments by each rendering provider. Shows a percent of total for each provider.
Recurring Claims - Sample - Shows recurring claims by patient. Columns include name, service date, procedure codes, units, and charges.
Referring Provider Patient Count - Sample - Shows the name of the referring provider, the number of patients referred, the claim count, total charges and applied amount. Can double click to drill down and see detail data.
Patient Ledger with No Payments - Same as the patient ledger but excludes payments.
Diagnosis Code Summary - Lists the primary diagnosis code in order of usage.
Physician Library List Report - Standard Physician Library List report but includes the address. This report will not show up in the report list. It is accessed from the physician library screen by clicking the 'Library List Report' button.
Mailing Labels - Patient Birthday - Sample - Monthly birthday mailing labels showing the Patient's name and address information. The program will ask for the month of the birthday. Uses standard single sheet mailing labels 3 across and 10 down.
Updated CMNs - Will print the NPI in the Supplier and Physician areas correctly. Enter the NPI number into the Physician Library into the NPI number field. The old CMNs will print data even if no facility is selected on the Charges screen.
Delivery Ticket - Sample - Delivery ticket to show items and descriptions of items on the claims regardless if a Facility or a Payer were selected for that patient's claims. The Balance After Insurance is either the Patient Amount due or if it's $0.00, the program will calculate it by taking the line item Charges and subtracting the Allowed Amount.
Referring Provider Patient Count - Sample - Shows the number of patients referred by each referring physician. Also shows the claim count. Double click the physician name to get the patient visit detail.
Standard Follow-up Report without Claim Notes - Sample - Standard EZClaim follow-up report without the claim notes. This is a special report used to show claim follow-ups. It does not appear in the normal report list. To run the report, click the Follow-Up Report Preview button on the Charges screen (next to the follow-up date and reference).
Ohio MACSIS Submission Report - Advanced 6 or 7 - Sample - Submission report from Ohio EZClaim 2.3. Users that have upgraded to version 5.0 but still want to use the older submission report should download and install this report.